Provider Demographics
NPI:1730342031
Name:WEASTER, KIMBERLY S (MED, LPC, NCC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:WEASTER
Suffix:
Gender:F
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3209 WHITE POST RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-5432
Mailing Address - Country:US
Mailing Address - Phone:512-423-3913
Mailing Address - Fax:512-331-0158
Practice Address - Street 1:3209 WHITE POST RD
Practice Address - Street 2:CEDAR CABIN COUNSELING
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-5432
Practice Address - Country:US
Practice Address - Phone:512-423-3913
Practice Address - Fax:512-331-0158
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61618101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor